Acute lamotrigine overdose: a systematic review of published adult and pediatric cases

Alyahya, Bader; Friesen, Marjorie; Nauche, Bénédicte; Laliberté, Martin

doi:10.1080/15563650.2017.1370096

Cited by 41 publications

(41 citation statements)

References 46 publications

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“…Twenty percent of patients in the 2018 review of LTG overdose were given NaHCO 3 as part of their treatment, and the effect was variable. The QRS complex did not correct in four cases . Detrimental side effects of sodium bicarbonate are well documented and include acute alterations in sodium concentration, hypokalemia, and paradoxical acidosis .…”

Section: Discussionmentioning

confidence: 91%

“…Complete heart block and pulseless VT were also described . In a 2018 review of 51 cases of acute LTG overdose, the most frequently reported cardiac abnormality was tachycardia; with 21% of people demonstrating QRS widening, and 6% of patients experiencing cardiac arrest . Doses of 100‐40 000 mg have been reported to cause CNS and cardiac toxicity in people .…”

Section: Discussionmentioning

confidence: 99%

“…1 The time between toxic ingestion and presentation to the emergency room is frequently unknown. As such, measured levels of LTG may not correspond to the severity of clinical signs 10 and drug levels are not clinically relevant in the acute setting due to the time delay in obtaining results. 9 Levels of LTG were not measured in this case report.…”

Section: Discussionmentioning

confidence: 99%

“…The QRS complex did not correct in four cases. 10 Detrimental side effects of sodium bicarbonate are well documented and include acute alterations in sodium concentration, hypokalemia, and paradoxical acidosis. 13 Patients administered NaHCO 3 must have the ability to ventilate appropriately as a by-product of metabolism in vivo is CO 2 .…”

Section: T a B L E 3 Serum Biochemistry Values In A Dog Presented Formentioning

confidence: 99%

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The use of intralipid emulsion therapy to treat severe cardiotoxicity secondary to lamotrigine ingestion in a dog

Bellis¹,

Gibeon²

2018

Clinical Case Reports

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: T a B L E 3 Serum Biochemistry Values In A Dog Presented Formentioning

confidence: 99%

See 2 more Smart Citations

The use of intralipid emulsion therapy to treat severe cardiotoxicity secondary to lamotrigine ingestion in a dog

Bellis¹,

Gibeon²

2018

Clinical Case Reports

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“…6). The consequences of acute LTG overdoses may be compared with the situation in Ca v 2.3-deficient mice and were summarized recently characterized mostly by mild or no toxicity [25]. But some cases with very high serum LTG levels (> 25 mg/L) accidentally caused in a child led to severe and polymorphic neurological symptoms acutely [26].…”

Section: Discussionmentioning

confidence: 99%

Cav2.3 (R-Type) Calcium Channels are Critical for Mediating Anticonvulsive and Neuroprotective Properties of Lamotrigine In Vivo

Dibué-Adjei

Kamp

Alpdogan³

et al. 2017

Cell Physiol Biochem

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Background/Aims: Lamotrigine (LTG) is a popular modern antiepileptic drug (AED), however, its mechanism of action has yet to be fully understood, as it is known to modulate many members of several ion channel families. In heterologous systems, LTG inhibits Ca_v2.3 (R-type) calcium currents, which contribute to kainic-acid- (KA) induced epilepsy in vivo. To gain insight into the role of R-type currents in LTG drug action in vivo, we compared the effects of LTG to topiramate and lacosamide in Ca_v2.3-deficient mice and controls on KA-induced seizures. Methods: Behavioral seizure rating and quantitative electrocorticography were performed after injection of 20 mg/kg [and 30 mg/kg] KA. One hour before KA injection, mice were pretreated with either 30 mg/kg LTG, 50 mg/kg topiramate (TPM) or 30 mg/kg lacosamide (LSM). Results: Ablation of Ca_v2.3 reduced total seizure scores by 28.6% (p=0.0012) and pretreatment with LTG reduced seizure activity of control mice by 23.2% (p=0.02). In Ca_v2.3-deficient mice LTG pretreatment increased seizure activity by 22.1% (p=0.018) and increased the percentage of degenerated CA1 pyramidal neurons (p=0.02). All three tested AEDs reduced seizure activity in control mice, however only the non-calcium channel modulating AED, LSM had an anticonvulsive effect in Ca_v2.3-deficient mice. Furthermore LTG altered electrocorticographic parameters differently in the two genotypes, decreasing relative power of ictal spikes in control mice compared to Ca_v2.3-defcient mice. Conclusion: These findings give first in vivo evidence for an essential role for Ca_v2.3 in LTG pharmacology and shed light on a paradoxical effect of LTG in their absence. Furthermore, LTG appears to promote ictal activity in Ca_v2.3-deficient mice resulting in increased neurotoxicity in the CA1 region. This paradoxical mechanism, possibly reflecting rebound hyperexcitation of pyramidal CA1 neurons after increased inhibition, may be key in understanding LTG-induced seizure aggravation, observed in clinical practice.

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Psychotropic Drugs in Special Conditions

2021

The Maudsley Prescribing Guidelines in Psychiatry

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This chapter provides brief details of the toxicity in overdose of commonly used psychotropics. It is intended to help guide drug choice in those thought to be at risk of suicide, to give some indication of safe quantities to prescribe and to help identify symptoms of overdose. In all cases of suspected overdose, urgent referral to acute medical facilities is, of course, strongly advised. Everyone has a duty to drive reasonably, and in almost all countries drivers are legally responsible for accidents they cause whether or not under the influence of drugs and alcohol. Many factors have been shown to affect driving performance. In the UK, severe mental disorder is a prescribed disability for the purposes of the Road Traffic Act 1988. Many psychotropics can impair alertness, concentration and driving performance. There are few studies of the effects of non‐anaesthetic drugs on surgery and the anaesthetic process.

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Acute lamotrigine overdose: a systematic review of published adult and pediatric cases

Cited by 41 publications

References 46 publications

The use of intralipid emulsion therapy to treat severe cardiotoxicity secondary to lamotrigine ingestion in a dog

The use of intralipid emulsion therapy to treat severe cardiotoxicity secondary to lamotrigine ingestion in a dog

Cav2.3 (R-Type) Calcium Channels are Critical for Mediating Anticonvulsive and Neuroprotective Properties of Lamotrigine In Vivo

Psychotropic Drugs in Special Conditions

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